USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT€¦ · (NGOs): Vietnam Assistance to the Handicapped (VANH), East Meets West Foundation (EMW), and Save the Children (SC). Funding

USAID/VIETNAM: DISABILITIES

AND HEALTH ASSESSMENT

DECEMBER 2010

This publication was produced for review by the United States Agency for International

Development. It was prepared by Piet De Mey through the Global Health Technical

Assistance Project.

USAID/VIETNAM: DISABILITIES

AND HEALTH ASSESSMENT

DISCLAIMER

The views of the authors expressed in this publication do not necessarily reflect the views of the United

States Agency for International Development or the United States Government.

This document (Report No. 10-01-419-02) is available in printed or online versions. Online documents

can be located in the GH Tech website library at http://resources.ghtechproject.com. Documents are

also made available through the Development Experience Clearinghouse (http://dec.usaid.gov).

Additional information can be obtained from:

The Global Health Technical Assistance Project

1250 Eye St., NW, Suite 1100

Washington, DC 20005

Tel: (202) 521-1900

Fax: (202) 521-1901

[email protected]

This document was submitted by The QED Group, LLC, with CAMRIS International and Social &

Scientific Systems, Inc., to the United States Agency for International Development under USAID

Contract No. GHS-I-00-05-00005-00

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT i

CONTENTS

ACRONYM LIST ............................................................................................................... iii

EXECUTIVE SUMMARY................................................................................................. vii

Review of the USAID-funded Disability Program in Danang .......................................................... vii

The Road Forward ...................................................................................................................................... x

The Future Program................................................................................................................................... xi

I. INTRODUCTION ....................................................................................................... 1

Background and Context ........................................................................................................................... 1

Assessment: Purpose and Methodology ............................................................................................... 2

II. REVIEW OF CURRENT USAID-FUNDED DISABILITY PROGRAM

IN DANANG ............................................................................................................... 5

Background and Context ........................................................................................................................... 5

Findings of the Assessment of the Disabilities Program in Danang ................................................. 5

III. HEALTH ASSESSMENT ............................................................................................ 9

Key Findings of the Health Assessment ................................................................................................. 9

Other Donor Activities ........................................................................................................................... 12

IV. THE WAY FORWARD ............................................................................................ 13

Recommendations from the Assessment ........................................................................................... 13

APPENDICES

APPENDIX A. SCOPE OF WORK ............................................................................... 21

ii USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT iii

ACRONYM LIST

ANC Antenatal care

ADL Activities of daily living

AEPD Association for Empowerment of Persons with Disabilities

AIFO Associazione Italiana Amici di Raoul Follereau

AO Agent Orange

AOWG Agent Orange Working Group

APS Annual Program Statement (USAID)

ASCON Asian Spinal Cord Network

CBCT Community-based clubfoot treatment

CBR Community-based rehabilitation

CDC Centers for Disease Control and Prevention (U.S. Government)

COV Children of Vietnam

CP Cerebral palsy

CRP Comprehensive Rehabilitation Plan

CRS Congressional Research Service

CRSP Comprehensive Rehabilitation Support Package

CWD Children with disabilities

DAVA Danang Association for Victims of Agent Orange

DCC Danang Coordination Committee

DCG Disability Coordination Group

DCH Danang Cancer Hospital

DISLOW Disability low threshold

DISHIGH Disability high threshold

DOET Department of Education & Training

DOFA Department of Foreign Affairs

DOH Department of Health (province)

DOLISA Department of Labor, Invalids and Social Assistance

DPO Disability People’s Organization

DRD Disability and Resource Development

EMW East Meets West Foundation

ESSP Economic stimulus support package

FF Ford Foundation

GDO General Development Office

GH Tech Global Health Technical Assistance Project

GVN Government of Vietnam

HIB Handicap International Belgium

HRCS Holistic Rehabilitation Coordination System

HHS Department of Health and Human Services

ICF International Classification of Functioning, Disability and Health

iv USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

IDEA Inclusive Development Action

IEC Information, education, and communication

IOM Institute of Medicine (U.S.)

IRS Integrated Rehabilitation System

JAC Joint Advisory Committee (on Agent Orange/dioxin-related issues)

JICA Japanese International Cooperation Agency

KAP Knowledge, attitudes, and practices

LOE Level of effort

MCH Maternal and child care

MCNV Medical Committee Netherlands-Vietnam

M&E Monitoring and evaluation

MOET Ministry of Education and Training

MOFA Ministry of Foreign Affairs

MOH Ministry of Health

MOLISA Ministry of Labor, Invalids and Social Assistance

MONRE Ministry of National Resources and Environment

MOU Memorandum of understanding

NAP National Action Plan

NGO Nongovernmental organization

NLR Netherlands Leprosy Relief

ORH Orthopedics and Rehabilitation Hospital

PC People’s Committee

P&O Prosthetics and orthotics

PWD People with disabilities

QA Quality assurance

QI Quality improvement

RC Rehabilitation coordinator

RF Result framework

RFA Request for applications

SC Save the Children

SHG Self-help group

SN-PWD Support Network for People with Disabilities

SOW Scope of work

STI Sexually transmitted infections

SW Social worker

TCDD 2,3,7,8-Tetrachlorodibenzo-p-dioxin

UNDP United Nations Development Program

UNICEF United Nations Children’s Fund

U.S. United States of America

USAID United States Agency for International Development

USG United States Government

VA Veterans Affairs (U.S.)

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT v

VAVA Vietnam Association for Victims of Agent Orange

VHLSS Vietnam Household Living Standards Survey 2006

VN Vietnam

VNAH Vietnam Assistance for the Handicapped

VNRC Vietnam Red Cross

VPHA Vietnam Public Health Association

VSO Voluntary Service Overseas

VVAF Vietnam Veterans of America Foundation

WB World Bank

WHO World Health Organization

WV World Vision

vi USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT vii

EXECUTIVE SUMMARY

Although the Vietnamese and U.S. governments have been moving toward normal bilateral

relationships, the issue of Agent Orange and dioxin contamination remains a topic under

discussion. Forums have been established to address the legacy of Agent Orange in Vietnam,

including the U.S.-Vietnam Dialogue Group on Agent Orange/Dioxin (initiated and supported by

the Ford Foundation) and the U.S. Government-Government of Vietnam Joint Advisory

Committee (JAC) to provide guidance on scientific cooperation, technical assistance,

environmental remediation related to Agent Orange and dioxin contamination, and health-

related activities for communities adjacent to dioxin hotspots.

In 2008, as part of the broader joint effort between the Government of Vietnam (GVN) and the

U.S. Government to address the environmental contamination near former Agent

Orange/dioxin sites, USAID/Vietnam awarded three grants to provide assistance to people with

disabilities (PWD) living in communities adjacent to the airport in Danang. The USAID/Vietnam-

supported program, Strengthening Services for the Disabled in Danang, has an overall goal of

providing comprehensive medical and social rehabilitation services for PWD, responding to

health, education, livelihood, and social integration needs, with a total budget of $2.9 million

over three years. Although focused on areas adjacent to the hotspot, the program assists PWD

regardless of the cause of disability, as it is difficult to determine conditions directly caused by

dioxin contamination. This program is implemented by three nongovernmental organizations

(NGOs): Vietnam Assistance to the Handicapped (VANH), East Meets West Foundation

(EMW), and Save the Children (SC). Funding for this program was from a congressional earmark

for environmental remediation of dioxin and health-related activities. Program funding ends in

September 2011.

The purpose of this assessment is: 1) to conduct a review of the current disability program in

Danang; 2) assess other public health needs in communities adjacent to dioxin hot spots; and 3)

provide recommendations on potential future (follow-on) assistance for interventions that

address on-going disability and public health issues in communities surrounding dioxin hotspots.

The external assessment was conducted in December 2010 for a period of three weeks in

Danang and Hanoi by a team of two international consultants with expertise in disabilities and

public health. The main sources of information were extensive document reviews, focus group

discussions, field visits to visit project sites and meet beneficiaries, and consultations with major

stakeholders at the central, provincial, district, and commune level, including Office 33, the

Ministry of Labor, Invalids and Social Assistance (MOLISA), Ministry of Health (MOH), members

of Parliament, Danang People’s Committee, Department of Labor, Invalids and Social Assistance

(DOLISA), Department of Health/province (DOH), and residents in dioxin-contaminated

communities, in addition to U.S. Government and other donor and international organizations

(UNICEF, UNDP, WHO) and foundations (Atlantic Philanthropies, Ford Foundation). The

collected data were analyzed, including triangulation of the gathered information, and the report

prepared.

REVIEW OF THE USAID-FUNDED DISABILITY PROGRAM IN DANANG

Despite the delayed start and challenges encountered by each NGO related to providing the

proposed services and activities, the team found that there were many accomplishments,

including the following:

viii USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

Key Program Achievements

The overall program addresses identified needs of PWD and beneficiaries’ requests for

services, and contributes to the number of PWD receiving support and training. PWD

especially appreciated training for livelihoods, job seeking, etc., as economic opportunities

are a priority need.

The staff of each NGO is committed to improving the lives of PWD and has been

resourceful in utilizing resources to help meet this objective.

The NGOs work closely with all levels of government (provincial/municipal, district, and

commune), and program activities are in line with the Danang Provincial Disability Action

Plan. Close collaboration with government has contributed to increasing the visibility and

awareness of PWD and the challenges they face.

Rehabilitation services at the Orthopedic Hospital, district, commune, and community level

were strengthened. Training was provided to local providers (e.g., DOLISA, DOH,

community collaborators) to deliver rehabilitation services.

The Disabilities Coordination Committee for all stakeholders (NGOs, UN/international

organizations, and government) has been established and plans are in place for more regular

meetings to be organized by EMW and UNICEF in 2011.

Coordination among the three implementing NGO partners has improved and a mechanism

is in place for monthly meetings to facilitate the exchange of information and collaboration.

NGO partners are each addressing MOLISA/DOLISA’s plan to establish a system of social

work and address the need for improved counseling and rehabilitation management.

Specific achievements include: registering 8,294 PWD in the program and screening 5,208.

By September 2010, rehabilitation supports and services, corrective surgeries, assistive

devices, and medical treatment had been provided to 2,857 PWD. Community-based

rehabilitation units were started in several communes. Technical and capacity-building

training was provided to 861 local service providers. Students with disabilities (301) were

given multiyear educational assistance to continue in school. Support was given to 20 PWD

to repair homes. Training on disability policies, care, and community-based rehabilitation

techniques was given to 385 disabled people and caregivers. In addition, several forms of

assistance were given to increase economic opportunities for PWD. Support was also given

to establish the first Disabled People Organization (DPO) in Danang and self-help groups

(SHGs).

GVN officials interviewed in Hanoi and Danang (including the People’s Committee)

expressed appreciation for the U.S. Government’s remediation program to clean up the

airport as a way to prevent future contamination. At the same time, the GVN and most

other interviewees said they value USAID’s assistance for the disabilities program in dioxin-

contaminated areas. Interviewees also said they look forward to working together with

USAID to plan and implement follow-up programs for people in these areas, in addition to

continue covering all seven districts, as people frequently migrate from dioxin-contaminated

communes to other parts of the city.

The Following Challenges Were Identified:

The three-year time period is very short for meeting program objectives, which often

require establishing new services and upgrading existing facilities.

NGO partners are confronted with competing demands, e.g., strengthening systems versus

addressing the needs of individuals and families; and increasing the number of beneficiaries

versus addressing issues related to service quality.

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT ix

Social assessments are conducted but are often fragmented because of limited resources,

addressing only certain aspects of the rehabilitation process. Some program staff,

community collaborators, and local/commune government staff have inadequate disability

training and experience.

The DPO has received legal status and SHGs have been established, but are new and not yet

fully functional.

Each NGO partner has a system of follow-up, but this is limited and would benefit from

more technical expertise to assess appropriateness and quality of services.

All implementing partners work with collaborators at the commune and community level.

The involvement of collaborators is in line with GVN’s approach to support at the

community level, but presents challenges related to experience, training, and

coordination/supervision, in addition to sustainability.

Financial support in the form of grants and/or loans to establish home businesses is a

priority among beneficiaries, but also presents many challenges and problems. Access to

microcredit is limited for PWD.

Detailed transition strategies were not included in the initial project proposals and planning,

as they were NGO proposals and were not negotiated in detail with government

institutions.

Assessment of Health-related Issues

The assessment team looked at broader public health issues and needs primarily in communities

adjacent to dioxin hotspots in Danang, including extensive review of relevant documents and

consultation with major stakeholders. Health services are vertical and not integrated, requiring

people to make repeated visits to health centers for each type of care needed. Most program

beneficiaries are poor and therefore qualify for health insurance, but many still have to pay

associated costs for care. Other financial challenges include transport costs, drugs from the

private sector, and costs not covered by health insurance, among others. Referral to the district

and provincial level for specialized services also poses challenges, as the referral system is weak.

It was also noted that working between GVN ministries and departments is challenging, e.g.,

coordinating activities between MOLISA and MOH and between DOLISA and DOH, which

could pose greater problems if support for initiatives related to health are increased in the

future and therefore will need to be addressed in the planning process.

Health Issues Related to Dioxin Contamination

The assessment team made efforts to collect information from a number of sources on health

issues related to dioxin contamination. These included the Institute of Medicine (IOM) report

Veterans and Agent Orange: Update 2008, Office 33’s draft National Action Plan on

Comprehensive Overcoming of Consequences of Toxic Chemicals Used by the United States

During the War in Vietnam to 2015 and Orientation Towards 2020, scientific research papers,

the Declaration and Plan of Action of the U.S.-Vietnam Dialogue Group on Agent

Orange/Dioxin, minutes of the U.S.-GVN Joint Advisory Committee, and advocacy materials

from Vietnam Assistance for the Handicapped (VAVA), among other documents. Although it

was difficult to obtain information on disease-specific conditions related to dioxin, (e.g., the

health information system/database is weak and GVN did not respond to requests for

information), there were several key findings:

Most people interviewed in districts adjacent to the airport said they did not know much

about Agent Orange and did not recall any health information campaigns. However, Hoà

Khê Commune Health Facility recently received pamphlets and brochures on the risk of

dioxin-contaminated food, which could be part of the Vietnam Public Health Association’s

x USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

planned knowledge, attitudes, and practices (KAP) survey and health education intervention

in Danang.

The first health examination of a total population (15,000) was conducted in late 2010 in

Hoà Khê commune. The analysis of the examination will be available in nine months and was

funded by GVN at the central level. The examination was not described as being dioxin-

related, although this commune is located next to the dioxin hotspot.

Although local communities adjacent to the hotspot are exposed to dioxin and other

pollutants, there is no Environmental Health Department at provincial level and the MOH

Department is newly established.

THE ROAD FORWARD

The following recommendations are based on the assessment findings:

Key Recommendations for the Current Disability Program:

A primary recommendation for future support is to build on lessons learned from the

experiences of the three NGOs implementing the current program. Major achievements to

build on are the electronic database including all PWD and the social assessment skills gained

within the sector, together with the insight into all available rehabilitation opportunities existing

in Danang. In addition, as interventions in Danang are shown to be successful, these models

could be scaled up and replicated in other dioxin hotspots.

The program should be closely planned with DOLISA to build on current experience and

ensure donor and multisector coordination, working with and through existing structures.

Planning should include a transition strategy, with the GVN assuming responsibility for

coordination of the rehabilitation process, as well as arranging for the provision of social

services for PWD.

There is a need for a multisectoral intervention, with social intervention as the main focus

and coordinator, in accordance with GVN policy. Technical interventions need to work

through the responsible government department (DOH, Department of Education &

Training [DOET], etc.)

The Disabilities Coordination Committee in Danang needs to meet regularly. In addition to

updating the detailed mapping of all government and other organizations that support PWD

in Danang, the whole sector needs to work on standardization of procedures and

optimization of tools, as well as on the review of the many models that exist of community

volunteers and collaborators to assess their effectiveness and sustainability.

During the final year of the current program, sharing of resources could be improved

through increased referral and sharing of services between the three implementing NGOs.

Key Health-related Recommendations

Remove barriers and improve access: physical, (e.g., ramps); financial (improving access to

health insurance for the poor and covering out-of-pocket expenditure); communication,

(sign language (deaf), Braille (blind)).

Early screening and early intervention programs, including for newborns and children under

the age of 6 years. There are many initiatives for early detection and screening in Vietnam

and Danang that need to be reviewed, with lessons learned used to scale up and integrate

successful approaches into health services and improve the quality of health services such as

antenatal care, safe delivery, and other prevention programs.

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT xi

Quality-improvement initiatives need to be included.

Within USAID/Vietnam, improved internal coordination between programs and direct

involvement of the health sector in planning, decision-making, and monitoring is

recommended for the disabilities and health programs.

Key Recommendations Related to Dioxin Contamination

Although the remediation program for cleaning up hotspots is a priority to prevent future

contamination, those interviewed from the government, People’s Committee, and others all

recommended that USAID continue support for PWD in dioxin-contaminated areas.

Support for broader health-related issues (e.g., strengthening integration of services and the

referral system, training for health staff, etc.) was viewed as steps to improve the overall

quality of the health system that would be beneficial to PWD and all members of affected

communities. It was noted that most diseases have multiple causes, making it difficult to

certify a direct link to dioxin and therefore it is best to improve services for all. Contracting

for integrated services and chronic disease clinics at the commune and district level were

identified as key health interventions to improve services for the whole population, not

just PWD.

The Declaration and Plan of Action of the U.S.-Vietnam Dialogue Group on Agent Orange

2010-2019 outlines several options for joint health-related issues, which in general support

the recommendations of the assessment team. For example: “Work with the government

health system and NGOs to improve public health and prevent further dioxin exposure, and

to improve service delivery to people with disabilities, including those who may have been

affected by dioxin.”

Active participation in JAC provides a forum for discussing health issues and potential future

support.

Activities to strengthen data collection/management and to establish health databases would

be beneficial in general, in addition to providing better documentation of health information

in dioxin-contaminated areas.

THE FUTURE PROGRAM

The assessment report includes a detailed discussion of proposals for future programs, taking

into consideration potential funding over five years, including support for PWD and broader

health initiatives if additional funding beyond the current $1 million yearly becomes available.

The recommendation is for a core disability program providing comprehensive services, closely

planned with DOLISA, based on a social worker coordination model, in line with the national

framework. The program could be more efficiently implemented with one primary grantee

collaborating with DOLISA to establish a Holistic Rehabilitation Coordination System (HRCS) of

social workers, who would serve as coordinators of a comprehensive rehabilitation plan (CRP).

In addition to including all aspects of the rehabilitation (health, education, economic

empowerment, and social inclusion), the CRP would accommodate future needs. A

comprehensive program could include a form of flexible rehabilitation grant for poor

beneficiaries. For quality assessments/improvements of existing rehabilitation services and the

extension of services in each of the four sectors, the USAID-supported program could work

through subcontracted, local, or international specialized agencies that partner with the

respective governmental bodies responsible for each sector.

If additional funding is available for a health program with benefits for the whole population,

including PWD, the recommendation is to invest in improving integration of health services and

strengthening of chronic disease management at commune health facilities. These interventions

are not directly linked but rather have common interfaces to the disability program. Both of

xii USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

these interventions could be implemented by contracting government services through a

performance-related agreement. As with a disability program, sector coordination is also needed

before engaging in a health program.

USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT 1

I. INTRODUCTION

BACKGROUND AND CONTEXT

Although the Vietnamese and U.S. governments have been moving toward normal bilateral

relationships, the issue of Agent Orange and dioxin contamination remains a topic under

discussion. In 2002, the first formal U.S.-Vietnam scientific conference on Agent Orange/dioxin

was held, which was followed by field work to document environmental and human health

effects, and by workshops on remediation techniques. Twenty-eight dioxin hot spots with

varying levels of contamination were pinpointed in southern Vietnam. The most affected areas

are surrounding the Danang, Biên Hòa, and Phu Cat airports, where the herbicides were stored,

leaked, or spilled during handling and the dioxin soaked into the soil or moved with rainwater

into the sediment of nearby rivers, lakes, and ponds, and on into the food chain (“Declaration

and Plan of Action,” U.S.-Vietnam Dialogue Group. June 2010). Related to the environmental

investigations, forums have been established to address the legacy of Agent Orange in Vietnam,

including the U.S.-Vietnam Dialogue Group on Agent Orange/Dioxin (initiated and supported by

the Ford Foundation) and the U.S. Government-Government of Vietnam Joint Advisory

Committee (JAC) to provide guidance on scientific cooperation, technical assistance, and

environmental remediation related to Agent Orange and dioxin contamination, and health-

related activities for communities adjacent to dioxin hotspots. In addition to providing support

for dioxin cleanup and small monthly allowances for people with disabilities believed caused by

Agent Orange, the Government of Vietnam (GVN) in 1999 formed the interagency Steering

Committee 33 to guide government decision-making. Other organizations in Vietnam addressing

the effects of dioxin contamination are the Vietnam Red Cross, which assists the disabled poor,

and the Vietnam Association of Victims of Agent Orange, which was set up as an advocacy

organization and also provides assistance to local residents.

As part of the broader joint effort between the GVN and the U.S. Government to address

environmental contamination near former Agent Orange/dioxin sites, including programs for

environmental remediation and for health, in 2008 USAID/Vietnam awarded three grants to

provide assistance to people with disabilities (PWD) living in communities adjacent to the dioxin

hotspot in Danang. The USAID/Vietnam-supported program, funded at a total of $2.9 million

over three years, has an overall goal of providing comprehensive medical and social

rehabilitation services for PWD, responding to health, education, livelihood, and social

integration needs. Funding for this program was from a congressional earmark for Agent

Orange.

A survey conducted by the Vietnamese General Statistics Office in 2006 found that

approximately 13.5% of the population in Vietnam have disabilities, although the numbers vary

greatly depending on the definitions used (Annual Program Statement 2008, p.1). People with

disabilities in Vietnam face significant challenges in accessing and obtaining information on

employment, health and education services, gaining legal rights, and accessing other essential

services. Beginning in 1989, USAID (including funds from the Leahy War Victims Fund) has

supported several disability-related activities in Vietnam, including medical rehabilitation,

inclusive education and vocational training, policy development, and advocacy. Through technical

assistance and direct funding for NGO activities, USAID has been responsible for raising

awareness at the national, provincial, community, and family levels regarding the needs and

abilities of children and adults with disabilities in Vietnam. The supported programs have

resulted in job training and development for adolescents with disabilities, improved access to

education for children in primary and secondary schools, provision of mobility aids and other

equipment and technician training for prosthetics and orthotics (P&O), screening and treatment

2 USAID/VIETNAM: DISABILITIES AND HEALTH ASSESSMENT

for hearing impairment, policy development and implementation, and expansion of self-help

groups, in addition to demonstrating and encouraging a national commitment and strategy for

inclusive education for all children with disabilities.

Building on this earlier experience, the current program, Strengthening Services for the Disabled

in Danang, is part of the effort to address the needs of communities in districts surrounding the

airport, where dioxin levels are high. Although focused on areas adjacent to the hotspot, the

program assists PWD regardless of the cause of disability, as it is difficult to determine

conditions directly caused by dioxin contamination. This program is implemented by three

nongovernmental organizations (NGOs): Vietnam Assistance to the Handicapped (VNAH), East

Meets West Foundation (EMW), and Save the Children (SC). Program funding is through

September 2011.

ASSESSMENT: PURPOSE AND METHODOLOGY

Purpose and Objectives

The purpose of the Vietnam Disabilities and Health Assessment is to conduct an external review

of the disability program and identify public health concerns in communities adjacent to dioxin

hotspots primarily in Danang and, to the extent feasible, in Phu Cat and Biên Hòa. During the

initial USAID briefing, it was decided to revise the scope of work (SOW) to focus on Danang, as

the time and funding available were too limited to include other hotspot areas and, in addition,

to focus on health needs for the same communities and target group of PWD living near dioxin

hotspots. The assessment was designed with three interrelated components:

1. Review the performance to date of the current USAID-funded disabilities program in

Danang, which began in October 2008

2. Look at broader public health issues and needs primarily in the communities adjacent to the

hotspots in Danang

3. Explore possibilities and provide recommendations for the future restructuring, refocusing,

or expansion of the current disabilities program, including disability prevention, early

intervention, and disability education, and explore additional health-related intervention

opportunities

Findings and recommendations from the program assessment are used primarily to inform the

design of possible follow-on activities for the period FY 2011-FY 2015, although some may be

used if time permits for minor adjustments/revisions during the final year of the current

program. Clarification of the intent of specific questions and other assessment concerns was

made during the first in-country briefing with USAID staff. The complete scope of work (SOW)

containing detailed assessment questions is found in Appendix A.

Methodology

This was an external evaluation conducted in December 2010 by a team of two international

consultants with expertise in disabilities and public health. The team was assisted by three part-

time translators, including a translator in a wheelchair who helped the team effectively

communicate with PWD and their groups. The main information sources were program,

government, and other partner documents; key informant interviews; and field visits to observe

project activities and meet beneficiaries. The team members were in-country for three weeks,

including 11 days in Danang.

Document Review: The team reviewed documents obtained from the Vietnamese and U.S.

governments and USAID; NGO program reports and survey instruments; and documents from


foundations, donors, and United Nations organizations, in addition to scientific papers on the

effects of Agent Orange and other documents related to dioxin contamination.

Key Informant Interviews: Based on the SOW and questions elicited from the document review

and USAID, the team developed a guide for key groups: USAID staff in Vietnam and

Washington; GVN officials from Office 33, Ministry of Labor, Invalids and Social Assistance

(MOLISA), Department of Labor Invalids and Social Assistance (DOLISA), Ministry of Health

(MOH), Department of Health/province (DOH), Department of Education & Training (DOET),

Department of Foreign Affairs (DOFA), Danang People’s Committee); United Nations

Organizations (UNICEF, WHO, UNDP, World Bank); bilateral donors (Irish Aid), Foundations

(Ford Foundation, Atlantic Philanthropies); NGOs including Vietnam Red Cross (VNRC),

Handicap International Belgium (HIB), Medical Committee Netherlands-Vietnam (MCNV),

Children of Vietnam (COV); implementing NGOs (EMW, Inclusive Development Action [IDEA],

SC, VNAH); and beneficiaries and their families. Three part-time Vietnamese interpreters

facilitated the interviews. Most interviews were conducted in person, with a small number

conducted by phone and email. Interviews with GVN central-level officers and international

donors and partners took place in Hanoi. The remaining interviews were conducted in Danang

at the provincial, district, and commune level, as well as with beneficiaries in communities and

homes.

Focus Groups: Two focus groups with program beneficiaries and non-beneficiaries were

conducted in Vietnamese by the translators. Another group meeting included members of the

Danang Disabled People’s Organization (DPO) and self-help groups (SHGs).

Site Visits: Team members visited and observed program activities with each of the three

implementing NGOs. Visits were also made to several partner institutions, such as GVN

vocational training programs and Employment Placement Services; factories and other

employment sites to observe PWD workers and meet employers; home-based businesses;

rehabilitation hospitals and rehabilitation units in District Health Centers and community-based

rehabilitation (CBR) centers; and the homes of beneficiaries. Two meetings were observed:

Agent Orange Working Group in Hanoi and Implementing Partners Coordination Meeting in

Danang.

Analysis: Team members took detailed notes during interviews and site visits. Information/data

from the document review, interviews, and site visits were analyzed (primarily qualitatively)

according to the evaluation questions in the SOW to ensure that team conclusions would be

based on data derived from several sources. In some cases, the team returned to interviewees

for further information or clarification. The team presented preliminary findings and

recommendations to USAID staff, USAID Mission Director, and U.S. Ambassador. The

comments and information generated from these debriefing discussions have been incorporated

into the writing of this report.



II. REVIEW OF CURRENT USAID-FUNDED DISABILITY

PROGRAM IN DANANG

BACKGROUND AND CONTEXT

The following discussion addresses the first task of the assessment, as stated in the SOW, and

reviews the performance to date of the current USAID-funded disabilities program in Danang,

which began in 2008 and is being implemented under grants to three NGOs.

As noted above, in 2008, USAID/Vietnam issued an Annual Program Statement (APS) to solicit

innovative concept papers from qualified NGOs capable of designing and implementing model

projects to provide support to people with disabilities in Danang, in particular the areas where

increased levels of dioxin have been identified in the environment. Programs and activities could

include, but were not limited to, enhancing earlier interventions for PWD, providing support to

existing rehabilitation clinics and services, expanding PWD access to essential health and

education services, initiating or strengthening CBR services and support, improving income-

generation and employment opportunities, strengthening the capacity of local organizations to

provide services, improve community-based information on reducing risk exposure, and

surveillance and prevention of disability. Because of pressure to move quickly and the fact that

there was no one application able to address all aspects of a comprehensive program, three

NGOs were given separate grants, each to address different components to meet the needs of

PWD and their families. VNAH focuses on rehabilitation services and socio-economic support;

EMW’s primary effort is to facilitate medical rehabilitation, including the setting up of a network

of CBR centers; and SC works to empower PWD through increased economic opportunities

and services.

Although the NGOs were funded in October 2008, most program activities did not begin

immediately, as there were delays in the GVN approval process for EMW and VNAH and in the

process of conducting a baseline disability assessment at district level, which was more time-

consuming than anticipated. EMW conducted surveys in five districts, and VNAH and SC

collaborated on conducting surveys in two districts (Hòa Vang and Liên Chiểu). The EMW

survey found a disability prevalence ratio of 1.27%. The survey in the two districts found 19%

and 22%, respectively. These rates are higher than those identified by any other survey, due to

the definition of disability used (any functional limitation). Other findings related to the types of

impairment (using concepts of the International Classification of Functioning, Disability and

Health [ICF]) and the low level of education among PWD. In addition, it was revealed that more

than one-third of the PWD lack access to health care. These are all factors that increase PWD

challenges.

FINDINGS OF THE ASSESSMENT OF THE DISABILITIES PROGRAM IN

DANANG

The assessment team spent two to two and a half days with each NGO, meeting with staff to

review the program in addition to making field visits to supported activities and beneficiaries.

Despite the slow start and many challenges encountered by each NGO during efforts to provide

the proposed services and activities, the team found that there were many accomplishments.


Key Program Achievements

Overall Program Achievement

The overall program addresses the identified needs of PWD and beneficiaries’ requests for

services, and contributes to the number of PWD receiving support and training. PWD

especially appreciated training for livelihoods, job seeking, etc., as economic opportunities

are a priority need and a necessary precondition for social inclusion.

The staff of each NGO is committed to improving the lives of PWD and has been

resourceful in utilizing resources to help meet this objective.

NGOs work closely with all levels of government (provincial/municipal, district, and

commune), and program activities are in line with the Danang Provincial Disability Action

Plan. Close collaboration with government has contributed to increasing the visibility and

awareness of PWD and the challenges they face.

Rehabilitation services at the Orthopedic Hospital, district, commune, and community level

were strengthened. Training was provided to local providers (e.g., DOLISA, DOH,

community collaborators) to deliver rehabilitation services.

The Disabilities Coordination Committee for all stakeholders (NGOs, UN/international

organizations and government) has been established and plans are in place for more regular

meetings to be organized by EMW and UNICEF in 2011. UNICEF takes an active role at the

national and provincial level in coordination and mapping of organizations working in

disabilities, in addition to supporting surveys and programs for PWD.

Coordination among the three implementing NGO partners has improved and a mechanism

is in place for monthly meetings to facilitate collaboration and information exchange.

The NGO partners are each addressing MOLISA/DOLISA’s plan to establish a system of

social work and respond to the need for improved counseling and rehabilitation

management.

Program-specific Achievements

Despite the delayed start, the assessment team found that the program had many

accomplishments, even in its short time frame. The following achievements are based on

interviews with and presentations by the three NGOs, field visits, interviews with GVN and

other partners supporting disabilities programs in Danang, and review of program reports.

Baseline Disability Surveys and Screening: As noted above, comprehensive disability surveys

have been completed in two districts and are to be completed in the five remaining districts.

Health Assistance to PWD: A total of 8,294 PWD have been registered in the program and

5,208 have been screened. By September 2010, rehabilitation supports and services,

corrective surgeries, assistive devices, and medical treatment had been provided to 2,857

PWD. CBRs had been established in 63 locations. Students with disabilities (301) were given

multiyear educational assistance to continue in school (EMW cost-share). The program also

assisted 224 people in registering for the local government welfare program. Support was

given to 20 PWD to repair homes and renovate water supply and sanitation facilities.

Training on disability policies, care, and CBR techniques was given to 385 disabled people

and caregivers.

Increased Economic Opportunities for PWD: PWD and caregivers (1,272) were trained in

job seeking, soft skills, and entrepreneurship-development skills. PWD and caregivers had

access to microfinance services (127); 154 PWD and 15 caregivers were employed by local

businesses; and 545 PWD and 56 caregivers started home-based businesses and/or

improved their income. Training in disability management and job accommodation for

employees with disabilities was given to 37 enterprises, local authorities, and social


organizations. Training in disability employment and income-generation opportunities for

PWD was provided to local officials, staff at vocational training centers, and business

associations and enterprises. Equipment and modification of infrastructure was provided at

two training centers.

Capacity Building in the Health Sector: Technical and capacity-building training was provided

to 861 local service providers, including social and health workers, CBR workers, local

doctors, and physical therapists. Three district hospitals were upgraded and equipped

(Thanh Khê, Cẩm Lệ, and Hòa Vang districts). The Danang Orthopedic and Rehabilitation

Hospital was assisted in developing a three-year strategic plan. Software for disability

information tracking and case management was completed and distributed to government

social and health service providers.

Support to Disabled People Organization: Support was given to establish the first legal DPO

in Danang, in addition to creation of self-help groups.

Key Program Challenges

The assessment team identified the following key program challenges:

The three-year time period is short for meeting program objectives, which often require

establishing new services and upgrading existing facilities, in addition to a long start-up time

(e.g., conducting baseline surveys).

Social assessments are conducted but are often fragmented because of limited project

resources and insufficient training of staff, community collaborators, and local/commune

government staff. It is difficult for NGOs to hire local staff with professional disabilities

training and experience. As a result, the program must provide time-consuming in-service

training. Any future intervention has to take care to further develop its own staff.

All implementing partners work with collaborators at the commune and community level.

The involvement of collaborators is in line with GVN’s (DOLISA and DOH) approach to

channel NGO support at the community level. At the same time, it presents challenges

related to experience, training, and coordination/supervision, in addition to sustainability.

Rehabilitation is a long process, normally extending over the course of a lifetime. Each NGO

partner has a system of follow up, but this is limited and would benefit from more technical

expertise to assess appropriateness and quality of services. In addition, many PWD need

more than one intervention, but the scope of assistance for each individual is limited, both

financially1 and in the number of needs that can be addressed.

Rehabilitation is multisectoral (health, education, economic, and social inclusion), which

presents challenges at all levels related to prioritizing needs, identifying available resources in

each sector, and especially to coordinating among sectors.

Financial support in the form of grants or loans to establish home businesses, a priority

among beneficiaries, also presents many problems and challenges. Access to affordable

microcredit is limited for PWD.

Although coordination among implementing partners has improved, there is still a need for

better alignment of interventions and referral for services between partners. For example,

different approaches to rehabilitation are supported by each NGO in addition to other

organizations supporting related PWD activities.

NGO partners are confronted with competing demands, e.g., strengthening systems versus

addressing the needs of individuals and families; increasing the number of people served

1 Estimated at < $148 for a direct benefit of a PWD/family.


versus improving service quality. For example, in addition to improving the PWD’s

individual/family situation, there is a need to remove broader situational barriers for PWD.

It is difficult for a single NGO to address all of these challenges.

Many older PWD need assistance, adding to the financial and social burdens on families.

However, due to limited resources, the program focuses on beneficiaries below 50 years of

age. Unless additional resources become available, program support needs to remain

focused on younger PWD.

The DPO has received legal status and self-help groups have been established by VNAH and

SC, but are new, not yet fully functional, and not utilized to their full potential.

The CBR units established at commune level do bring services closer to the community, but

need to be reviewed in terms of effectiveness, quality of services, and sustainability.

There were no limitations on the severity of impairment for beneficiaries in the current

phase. At least some of them had a minor impairment, such as lack of vision in one eye. It is

therefore impossible to calculate the beneficiaries of the current phase from a

comprehensive rehabilitation point of view, as the statistics are collected by intervention

and not by beneficiary. Some of them have made use several times of different services or

the same service, e.g. because employment failed, several surgeries were needed, or an

assistive device needed to be adapted to a child’s growth. Many of them had no educational

or economic rehabilitation.

Detailed strategies for transitioning activities at the end of program funding were not

included in the initial project proposals and planning.


III. HEALTH ASSESSMENT

The second component of the SOW requested that the assessment team look at broader public

health issues and needs primarily in the communities adjacent to the hotspots in Danang. To

address this issue, the team met with major stakeholders at the central, provincial, district, and

commune level, including Office 33, MOLISA, MOH, Members of Parliament, Danang People’s

Committee, DOLISA, DOH, and DOFA, and residents in communities in areas adjacent to

dioxin hotspots, in addition to U.S. Government agencies, including USAID, Centers for Disease

Control and Prevention (CDC), Department of Health and Human Services (DHHS), and other

donor and international organizations and foundations that are supporting and working with the

health sector (e.g., Atlantic Philanthropies, Ford Foundation, Irish Aid, UNICEF, WHO, UNDP,

MCNV, etc.).

KEY FINDINGS OF THE HEALTH ASSESSMENT

The key findings outlined below are based on interviews with the stakeholders listed above, in

addition to discussions with implementing partners and program beneficiaries and an extensive

review of relevant documents. Several of the findings are relevant to the general population. It

should also be noted that the current USAID-supported disabilities program includes health- and

medical-related activities.

Health services are not integrated, which necessitates that patients return to facilities

frequently for each type of vertical service, with transport identified as a major challenge.

The health referral system is weak, including lack of feedback to the referral source.

Systematic collection and use of health data is weak.

Although the assessment team learned about many pilot programs for early detection of

impairments, in general there is no systematic policy on early detection system and strategy

for intervention.

Resources at commune health facilities are limited, although Atlantic Philanthropies is

addressing this situation through a program to improve commune health facilities and

provide training for staff in all districts in Danang.

Working between GVN ministries and departments was described as challenging, e.g.,

coordinating activities between DOLISA and DOH, which could pose greater problems if

support for health-related initiatives is increased in the future and therefore needs to be

addressed in the planning process.

Most program beneficiaries in Danang are poor and have GVN health insurance; although

reports indicate that 30-40% of PWD lack insurance. The NGO implementing partners have

provided assistance to beneficiaries and families in obtaining certification, as it can be a

complicated, bureaucratic process that must be repeated on a yearly basis. Systematic

efforts to improve and simplify this process could be included as part of future program

support.

Even when covered by health insurance, PWD face special challenges and barriers accessing

health services:

- The most frequently cited problem is the challenge related to transportation.

- GVN health insurance does not ensure access to all specialized services needed by

PWD. The poor and PWD also incur high out-of-pocket health expenditures, even

when exempted.

- Physical accessibility to facilities is limited (e.g., stairs, no ramps).


- Many communication challenges exist (e.g., no sign language or Braille; attitude of staff).

- Services for the special needs of PWD are limited and sometimes of inadequate quality.

Medical personnel are often unfamiliar with PWD conditions and lack the necessary

training, although training supported by implementing partners has improved the

situation in some health facilities.

GVN expressed appreciation for the proposed remediation program to clean up the airport as a

way to prevent future contamination. At the same time, GVN, including Office 33, central and

municipal level officials, and the Vice Chair of the People’s Party in Danang, stated the need to

continue assisting people in areas affected by Agent Orange/dioxin, with officials saying they look

forward to working closely with USAID and its partners to develop future PWD programs.

GVN officials noted that, in addition to supporting districts adjacent to the airport hotspot,

future programs should continue to cover all seven districts in Danang, as there is frequent

migration of people from dioxin-contaminated districts to other areas in the city. Almost all

interviewees with international organizations and foundations encouraged USAID to continue

support for PWD in areas near the hotspots.

Health Issues Related to Dioxin Contamination

The assessment team made efforts to collect information from a number of sources on health

issues related to dioxin contamination. In addition to talking with most interviewees about

health concerns, letters were sent by USAID to the MOH and MOLISA prior to the assessment

requesting background information on dioxin, health statistics, and recommendations on people

to contact. Unfortunately, the GVN at the central and municipal levels failed to reply to these

requests; the requested information was not provided even during face-to-face interviews. In

Danang, health officials in medical facilities in districts surrounding the Agent Orange hotspot

said that they were unaware of any database on dioxin-related conditions. However, the first

commune-wide health examination (conducted for the total population) was carried out in Hoà

Khê commune (Thanh Khê district) in September and November 2010. Thanh Khê health

officials said that the results of this examination are expected to be available in mid-2011.

Funding for this examination was described as coming from the central level, through the MOH.

In response to the assessment team’s questions about the examination, respondents were vague

and referred to the national level for further information.

Key Findings for Health Issues Related to Dioxin Contamination

When interviewed, most beneficiaries living in areas adjacent to the airport hotspot said

they did not know much about Agent Orange, except what they heard through the media

on radio and TV. A few beneficiaries who had served in the army or been exposed during

the war had certification and were better informed about dioxin contamination.

Organizations such as Vietnam Association for Victims of Agent Orange (VAVA) are

informed about Agent Orange and distribute information about victims of dioxin

contamination as part of their advocacy programs. VAVA has a day care center and training

programs for children and youth with disabilities, including children with disabilities (CWD)

with mental disabilities, although most children at the center did not have certified dioxin-

related conditions.

It was not possible to obtain data specific to dioxin-related conditions from MOH/DOH or

DOLISA/MOLISA. For example, the following data was requested: MOH programs relating

to health/disabilities/dioxin issues; health statistics available for dioxin-related issues; health

statistics for specific hot spots; reports and studies on health issues in communities adjacent

to hot spots; and recommendations on whom to meet in government, service delivery, and

beneficiary groups.


The assessment team reviewed extensively the report Veterans and Agent Orange: Update

2008, prepared by the Committee to Review the Health Effects in Vietnam Veterans of

Exposure to Herbicides (Seventh Biennial Update), Institute of Medicine. This committee

concluded that “the information needed for assigning risk estimates continues to be absent

despite concerted efforts to model the exposure of the troops in Vietnam, to measure the

serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) concentrations of individual veterans,

and to model the dynamics of retention and clearance of TCDD in the human body” (page

10). However, the U.S. Congress and Veterans Administration (VA) does provide benefits

(disability compensation) to veterans who served in Vietnam diagnosed with the recognized

illnesses, without requiring proof of a direct association between their illnesses and military

service. (News Release, Department of Veterans Affairs, November 1, 2010). The Vietnam

Government’s Committee 33 works with GVN’s MOH and MOLISA to provide special

assistance to Vietnamese presumed to be suffering from conditions related to exposure to

Agent Orange. The Vietnamese list is similar to the U.S. Government/VA list. Office 33 also

has a draft National Action Plan on Comprehensive Overcoming of Consequences of Toxic

Chemicals Used by the U.S. During the War in Vietnam to 2015 and Orientation Towards

2020, which has not yet been approved by the GVN (Draft no. 5, 12 October 2009).

While many of the scientific papers available for review in Vietnam related to the

environmental impact of Agent Orange, the assessment team was also able to review

selected papers on the human health effects of Agent Orange/dioxin. It was difficult to

assess the scientific rigor of these studies. In most cases the findings were inconclusive.

A cancer hospital has been built and fully funded by the Danang municipal government and

local businesses. In addition, Atlantic Philanthropies constructed an oncology unit at the

Provincial Hospital. Therefore, further support for oncology and cancer-related conditions

from USAID and other donors is not a priority need in Danang.

Interviewees expressed concern about USAID’s interest in linking specific diseases, such as

cancers, to dioxin, and the potential implications for the U.S. Government. Several stated

(e.g., Ford Foundation, USAID/Washington) that in their long experience meeting with the

Vietnamese and U.S. governments, this issue has never been raised. Even within JAC and the

Scientific Advisory Committee on Dioxin, the major focus is on issues related to

remediation. Based on the minutes of JAC meetings, the discussion of health issues is

minimal except for the following noted needs:

- Research on exposure and potential health effects related to Agent Orange/dioxin

(2006)

- Public health system for birth defect surveillance, newborn screening, and prevention

without consideration to Agent Orange exposure (2007)

- IEC intervention on contamination (2007)

- Micronutrient fortification of staple foods to prevent birth defects (2010)

Although people interviewed were unaware of health education programs for communities

adjacent to the hotspot, the doctor at the Hoà Khê Commune Health Facility had copies of

a poster and brochure about dioxin, which are to be used in a future health education

program; however, commune health staff lacked information on the proposed plan. The

poster and brochure were developed and printed with support from the Ford Foundation

(FF) and Vietnam Public Health Association (VPHA). It was later learned that FF and VPHA

have piloted a knowledge, attitudes, and practices (KAP) survey on dioxin and food safety in

two communes near the Biên Hòa Airbase. The survey found that the risk of dioxin

exposure was high if people consume locally self-cultivated/raised foods (especially fresh

water fish and bottom mud feeders, free-range chicken, duck, toad, etc.) The VPHA-

supported intervention was described as improving the KAP of local residents, which


resulted in reducing the risk of exposure to dioxin in foods, currently the main source of

exposure. This intervention model is being expanded to Danang dioxin hot spots.

As noted by interviewees, including implementing partners, local populations are now

exposed to several contaminates/pollutants, including dioxin. Information about dioxin and

other pollutants is not widely available. To date, there is no environmental health

department at the provincial level; the Department of Environmental Health is newly

established at the central level. Responsibility for environmental health falls between the

MOH and the Ministry of Natural Resources and Environment.

OTHER DONOR ACTIVITIES

As noted above, VAVA, a self-supporting NGO, is active in raising the profile of the Agent

Orange/dioxin issues in Vietnam and the United States. In Vietnam, VAVA has exerted

pressure for greater efforts to clean up Vietnam’s environment and provide assistance to

those believed to be Agent Orange victims. In the United States, VAVA has been an active

proponent of greater U.S. assistance to Vietnam to address the Agent Orange/dioxin war

legacy. In 2006, VAVA sponsored a conference of victims of Agent Orange; the published

proceedings include summaries of studies and activities related to Agent Orange, which also

reflects VAVA’s advocacy role. VAVA receives funding through donations and memberships.

Since 2000, the Ford Foundation’s Special Initiative on Agent Orange has funded several

programs and initiatives aimed at addressing the impact of Agent Orange and dioxin on

post-war Vietnam. The foundation was instrumental in mobilizing support from the Bill and

Melinda Gates Foundation and the Atlantic Philanthropies to develop scientific facilities to

assess the impact of dioxin. It has also been the largest international contributor to the

clean-up effort at the Danang Airport. In addition, FF has supported the Aspen Institute in

helping establish the U.S.-Vietnam Dialogue Group on Agent Orange and supported its

efforts to promote the study of dioxin-related diseases, the creation of adequate healthcare

services for children and the disabled, environmental clean-up projects, and implementation

of scientific research.


IV. THE WAY FORWARD

RECOMMENDATIONS FROM THE ASSESSMENT

The following recommendations are based on information collected through document review,

interviews, field visits to health facilities, and visits with PWD in the community:

Recommendations for a Possible Future USAID-funded Disability Program

A primary recommendation for future support is to build on the National Action Plan for

Disability and on lessons learned from the experience of the three NGOs implementing the

current USAID program to ensure appropriateness and a better quality of assistance.

Donors need to closely coordinate the planning of support for PWD in Danang with the

People’s Committee and GVN Departments to increase coverage and complementarity.

Any potential overlap in project activities with other key stakeholders must be avoided

during the project design phase, during which there should be access to all governmental

planning tools within a well-defined policy framework from DOLISA. At the same time, the

effort will also require close collaboration and smooth coordination between the different

key partners and available service providers. In addition, DOLISA Danang needs to fully

assume its responsibility and take a pro-active coordination role in the local rehabilitation

sector to ensure a multisectoral approach. PC Danang needs to organize such broad donor

coordination on a yearly basis while assuming an advocacy role for mainstreaming PWD

support as part of all development initiatives.

Considering the scale of rehabilitation needs, estimated at 48,000 persons;2 the

multisectoral aspects of all the rehabilitation services, which need further development

(expansion and quality assurance); and the need for a professional Integrated Rehabilitation

System (IRS), it is advisable to take a multidonor, multipartner approach with different

specializations to tackle the challenge.

Donors need to closely coordinate the planning of support for PWD in Danang with the

People’s Committee and GVN Departments to increase coverage and complementarity.

Any potential overlap in project activities with other key stakeholders has to be prevented

during the project design phase, during which there should be access to all governmental

planning tools within a well-defined policy framework from DOLISA. At the same time, it

needs close collaboration and well-functioning coordination among all of the various key

partners and available service providers. DOLISA Danang should also assume fully its

responsibility and take a pro-active coordination role in the local rehabilitation sector to

ensure a multisectoral approach.

PC Danang needs to organize this broad donor coordination on a yearly basis in which it

should also assume the role of advocacy for mainstreaming PWD support in every

development initiative.

Future programs should strive for a more comprehensive, holistic approach, centered on

PWD and their family situations. Beneficiaries identified support for economic development

through improving access to low-interest microcredit loans and increasing livelihood

opportunities as priority areas.

As financial means are limited and have to be used in a cost-efficient way, it only makes

sense to support rehabilitation intervention for more people if service quality and quantity

2 That is, 5.33% of 900,000 people in Danang.


can be ensured. The assessment mission proposes that 40% of the total budget be reserved

for direct support to the target population of PWD with their families. USAID should hold

preliminary meetings, including discussions with all the proposed MOU partners (MOLISA,

DOLISA, PC Danang), specifying roles and inputs as well as the transition strategy for future

health-related intervention by USAID.

Social assessment and coordination of rehabilitation interventions should be performed

through a permanent actor with this in its mandate. Due to sustainability concerns, it is

proper to propose an investment to accompany DOLISA’s planned investment to establish a

system of social workers. These social workers could serve as coordinators of the

rehabilitation process for targeted PWD, supporting the GVN’s plan to strengthen social

work, including in-service training and services. MOLISA plans a nationwide effort by 2020

to educate and recruit 30,000 new social workers and upgrade 35,000 staff at all levels in

the system. These staff are already in service, though of course not only for disability

assistance. Even so, it is important to be realistic about the proposed social work program,

which will take years to be fully developed.

Initially, MOLISA-DOLISA will need substantial technical assistance as the groups diversify

their roles from direct service providers (day care centers, social protection centers, job

promotion centers, and financial subsidy supporters) toward a more holistic approach to

rehabilitation. USAID’s next disability-related program should be formulated so that the

partner works within the DOLISA structure at all levels to support and reinforce its

services.

If possible, it would be preferable to identify one primary coordinating USAID partner with

subpartners for technical interventions to better utilize limited program resources, improve

coordination, and be more efficient for the GVN. This was not possible at the time the

current grant was initiated in 2008, as innovative proposals were requested for intervention

without incorporating a strong accent on sustainability. In the future, USAID should define

the program itself to ensure a sustained focus on social assessment and development of an

Integrated Rehabilitation System (IRS) within DOLISA. Support proposals should also define

a transition strategy and identify what will remain at the end of the program to work toward

sustainability.

USAID/Vietnam is encouraged to consult and coordinate with the USAID/Washington and

the Leahy War Victims Fund to expand support for disabilities in Vietnam.

Given the Danang government’s commitment to PWD (e.g., Disability Action Plan, municipal

and district support for programs, etc.) and stated positive assessment of the USAID-

supported program, close collaboration in planning and implementing a future program

could then be monitored for effectiveness and replicated in other hotspot areas.

Access to public buildings for PWD needs to be improved. Recent legislation on disabilities

should be reviewed and implemented in health and other social service facilities. In addition

to improving physical access, communication services, e.g., Braille and sign language, are also

needed.

Adjustments to Current USAID Disability-related Interventions

1. As the electronic data bank of PWD is still in its design stage, all efforts should be made to

maximize its use as a practical tool for the entire rehabilitation sector in Danang in planning,

beneficiary selection, follow up, monitoring, etc.:

a. The data bank needs to be compatible with the new Disability Law, with each

intervention facilitating full implementation of the new law, particularly as it relates to

the following:

i. Types of impairments (mobility, hearing, speech, vision, mental, intellectual, other)


ii. Severity certificate given at commune level (light, moderate, or severe limitation)3

iii. Responsibilities of all involved stakeholders

b. The data bank needs to be able to generate potential candidates for priority

interventions, following agreed criteria, including severity levels, balance between the

types of disability assisted, poverty levels, geographic clustering of interventions, etc.

c. Data bank information should be updated continuously so it serves as a permanent

management tool.

d. Monitoring data must be streamlined and entered into the data bank by all intervening

partners to enable the documentation of progress and identification of gaps.

2. During the current program’s final year, sharing of resources should be improved through

increased referral and sharing of services among the three implementing NGOs.

3. Direct service provision such as training by grantees should be built gradually within the

next months by identifying suitable local institutions and providing capacity by organizing

trainings-of-trainers, so that these services can be obtained locally in the future.

4. Community-level training should concentrate more on target group education (family

members and PWD) and DOLISA and DOH staff rather than on training other

collaborators.

5. Every partner should critically analyze and document in a systematic way the successes and

challenges they have encountered in their rehabilitation processes and service delivery to

capture lessons learned, with lessons shared within sector meetings and incorporated into

future guidelines.

6. The Disabilities Sector Coordination Committee in Danang should meet regularly with the

participation of DOLISA and establish working groups to focus on the following key areas:

a. The total rehabilitation sector needs to be better documented and updated for use in

future planning exercises, including gathering information on spatial coverage by the

different partners, different coverage of the types of interventions, future funding

prospects for each partner, etc.

To develop an initial proposal on how DOLISA can establish an IRS in the Danang

Rehabilitation Sector Coordination Committee, it will be important to analyze the

various social assessments methodologies used for PWDs and families as well as the

different rehabilitation plan formats and follow-up methodologies from all key partners.4

This analysis should lead to the development of standardized procedures implemented

by all agencies.

b. Approaches to community-based rehabilitation should be reviewed in terms of

effectiveness and sustainability. Based on the findings, a model should be identified that

can be used in the future. DOH should be encouraged to provide leadership and

direction in this aspect.

c. The many models of community volunteers and collaborators need to be reviewed to

assess effectiveness and sustainability – for example, maintaining collaborators at the

commune level within the GVN, DOLISA and DOH; in addition, for each NGO,

including program NGOs, supporting different models of community volunteers and/or

collaborators. Future funding from USAID could include support for designing a model

based on lessons learned from the current non-surgical clubfoot rehabilitation

intervention, as proposed below.

3 Specified in Article 16 of the Vietnamese Law on PWD. 4 The assessment team has seen interesting social worker tools from other partners like Children of

Vietnam. All current practices have to be included into the standardization of social assessment.


Recommendations from the Health Assessment

The following broad recommendations are based on the assessment’s findings.

Support for broader health issues should build on this assessment’s findings, including the

need for further documentation of specific dioxin-related health needs. The lack of available

health data made it impossible for the current assessment to fully document the health

needs of this community. Support is needed for improving health data systems, which is

required for better support for future efforts to evaluate the health system.

All efforts to provide support for health-related issues should be discussed and planned with

the GVN, and integrated and built into the existing system.

USAID could collaborate with Atlantic Philanthropies to build on its support for improving

primary health care, including integrated services beginning at the commune level. PWD

would also benefit from integrated services to eliminate the need for repeat visits to

commune health services, which are currently vertically organized and discontinuous.

The health assessment identified general health needs/demands. Although many of them are

directly related to PWD, health services for the general population in areas near the hotspots

would also be improved. Specific recommendations are as follows:

Access to health insurance for the poor, including PWD, is still a challenge. There is a need

to both expand coverage and improve continuity.

Transportation is a major barrier for accessing health care services.

Disability-related training of health personnel (doctors, nurses, pharmacists, technicians,

paramedics), including pre-service and in-service training, should be based on review of

current training curriculums. Increased training on disabilities could contribute to improved

quality of care for PWD and others.

Existing initiatives for safe delivery and birth defect registration should be reviewed, such as

the pilot newborn screening programs implemented by such organizations as SC and HIB,

with future support built on these efforts. The program should include quality assurance in

the delivery ward (e.g., ANC referrals, partogram, C-section, Apgar score). A district birth

defect register at the district level could eventually be linked to prenatal screening (e.g.,

ultrasound, amniocentesis). At the same time, many impairments are difficult to diagnose at

birth, e.g., cerebral palsy (CP) and drop foot. It would therefore be logical to combine

newborn screening with early childhood detection and intervention. Several early detection

programs have been supported and piloted in Danang by UNICEF and in other provinces

(e.g., Irish Aid supports early detection in Vinh Long Province). Further support for

systematic early detection and intervention is needed. A first step is to review the existing

early detection systems and identify effective models, as future support needs to build on

these pilot programs.

Recommendations Related to Dioxin Contamination

The assessment team asked a range of interviewees (e.g., Atlantic Philanthropies, Ford

Foundation, USAID/Washington/Leahy War Victims Fund, international organizations,

MOH/DOH, MOLISA/DOLISA, and Vice Chairman of the Danang People’s Committee,

among others) for recommendations on Agent Orange-related health issues. The

respondents were consistent in recommending continuing support for disability-affected

areas in Danang, strengthening systems, building on the current program, and, depending on

resource availability, considering support for improving access to health services for

communities adjacent to the dioxin hotspot.


Supporting the establishment of an environmental health program in Danang was viewed as

a potential direction for future support from USAID, in addition to supporting the newly

established Department of Environmental Health at the central level within the MOH.

Through these programs, dioxin contamination could be addressed in combination with

issues related to other pesticides and food safety concerns. Strengthening environmental

health could be linked to environmental remediation activities, e.g., as preventive action

related to Agent Orange. The public is currently exposed to a wide range of pesticides and

toxic pollutants in addition to dioxin. Given this reality, the assessment team recommends

training health personnel in environmental health and preventing contamination from dioxin

and other pesticides and pollutants to help ensure that people receive accurate information

and screenings to reduce their risk of exposure.

Activities to establish health databases and strengthen overall data collection/management

would be beneficial, in addition to activities focused on improving documentation for health

information in dioxin-contaminated areas.

Given that many diseases have multiple causes, it is best to improve services for all by close

coordination with other programs in the health sector (e.g., Atlantic Philanthropies).

The outcome of the government health exam (15,000 in Hoà Khê commune) could provide

information on disease patterns in this commune surrounding the airport hotspot, although

there is no control group for comparison. In addition, observing how government shapes

the future public campaign about dioxin in Hoà Khê commune could be useful, as there

appears to be a need to better inform the public on dioxin and other pollutants, e.g., in

food. For example, the assessment team observed several people fishing in the lake adjacent

to the airport. With support from the Ford Foundation, the Vietnam Public Health

Association is replicating a health education program in Danang, which was first

implemented in Biên Hòa, including a KAP survey and a health education program on dioxin

in food. Future USAID support could build on the findings of these surveys on the risk of

exposure to dioxin. Implementation of such broader health-related activities will depend on

funding.

The U.S. Government and GVN meet annually through the auspices of the JAC to provide

guidance on scientific cooperation, technical assistance, and environmental remediation

related to Agent Orange/dioxin contamination and health-related activities for communities

adjacent to dioxin hotspots. The JAC provides a forum for discussing health issues and

potential future support. USAID is represented at the JAC by the Mission Director and

Head of the Health Office, who should therefore be involved in internal USAID discussions

and decision-making on these topics.

If future USAID-supported programs include health-related interventions, improved internal

coordination within USAID is recommended, including consultation and involvement of the

Health Section in planning and decision-making, developing the request for applications

(RFA), and program monitoring of interventions.

The Declaration and Plan of Action of the U.S.-Vietnam Dialogue Group on AO/Dioxin

2010-2019 outlines several options for joint health-related issues, which in general support

the assessment team’s recommendations. For example: “Work with the government health

system and nongovernmental organizations to improve public health and prevent further

dioxin exposure, and to improve service delivery to people with disabilities, including those

who may have been affected by dioxin.” As noted above, the recommendations include

among many priorities: creating a birth defect registry; developing a system for maternal

surveillance and screening; monitoring of child development and early-childhood

interventions to improve services to people in or near major hot spots; strengthening

training for Vietnamese public health professionals in disability diagnosis and treatment;

engaging public health professionals in developing educational programs to ensure that


people receive appropriate information and screenings to reduce their risk of dioxin

exposure; developing or strengthening rehabilitation facilities and respite day care centers in

provinces with high rates of people with disabilities; and, assisting the GVN in expanding

existing health insurance subsidy plans and scholarship programs to cover at least 70% of

poor households with people with disabilities or family members with illnesses associated

with exposure to dioxin.

Proposed Health Interventions Ranked in Order of Priority

As noted above, there are several options for supporting public health interventions in Danang

through the strengthening of public services. The assessment team identified and ranked a list of

priority USAID interventions, based on MOH priorities, public demand, and the feasibility and

coherency of the individual interventions:

1. Many of the options directly linked to disability deserve priority, as they are closely related

to PWD interventions and address areas that are part of a holistic disability support

program:

a. Physical, social, and sensorial barrier removal to access health care due to impairment

b. Impairment prevention, primary as well as secondary (early detection and intervention)

c. Quality assurance (QA) of specialized rehab services

d. Introduction of new services like community-based clubfoot treatment through the

expansion of the coverage of district rehabilitation departments

e. Quality improvement (QI) to specialized services at the provincial level

2. Under the category of improvements in the health system for all citizens, including PWD, QI

initiatives are ranked as follows:

a. Introducing integrated quality health services at the commune and district level,

especially in mother and child care, chronic diseases, and services for the elderly,

through contracting government services

b. Improving human resource development through pre-service and in-service training on

topics such as disability and chronic disease management

3. Expansion of existing services, mainly at the commune and district level, including

introduction of an improved chronic disease management system: diabetes type II,

hypertension, heart failure, Parkinson’s, etc.

4. Environmental health interventions related to hygiene and pesticide control

5. Epidemiological assistance for data collection and management, e.g., for specific diseases

including cancer, as well as chronic disease prevalence and causes of death

USAID has made substantial investments in disability-related programming in Vietnam for the

last 22 years, with a particular focus on Danang in the last 2 years. While there are many local

and international partners working in the Danang Rehabilitation Sector, USAID plays a critical

role in providing assistance to this community and should continue to invest in this area.

However, in its efforts to mitigate the effects of Agent Orange/dioxin exposure for communities

near the Danang airport, USAID should also look toward assistance in other health areas. PWD

are an especially vulnerable community that would benefit from a strengthened health system

that could also be used to benefit the general community. For this reason, the assessment team

included disability exclusive and non-exclusive health services in the list of possible future

interventions.

For health interventions that benefit both PWD and the general population, the assessment

team recommends two high-priority initiatives as potential USAID-supported health program


interventions. They target a broader population group with high need and demand for quality

basic health services:

Improved integration of health services at the commune level, e.g., for mothers with young

children (ANC, safe delivery, family planning, sexually transmitted infections [STI],

breastfeeding, vaccination, childhood illnesses, early detection and intervention, information,

education, and communication [IEC] needs, etc.), as transportation cost is a major barrier to

access.

Strengthening of chronic disease management at commune health facilities for an aging urban

society in an emerging middle-income country, where conditions such as diabetes,

hypertension, and heart disease – all potentially associated with dioxin – are increasing.

While these interventions are not directly linked, they do have common interfaces to the

disability program. Both of these interventions could be implemented by contracting

government or private services through a performance-related agreement. If there is

additional funding for each intervention, this could provide an extra advantage. It should only

start in close collaboration with the MOH/DOH. As for disability, sector coordination is

needed in this area before engaging in a health program.



APPENDIX A. SCOPE OF WORK

(Revised November 19, 2010)

I. TITLE

Activity: Assessment of USAID/Vietnam’s Disability-Related Program for Communities

Adjacent to Major Dioxin Hotspots in Vietnam

Contract: Global Health Technical Assistance Project (GH Tech), Task Order No. 01

Contract No. GHS-I-00-05-00005-00

II. PERFORMANCE PERIOD (SCOPE START AND END DATES)

The program assessment will be implemented over a period of approximately four weeks with

three weeks for field work, beginning on/about November 29th, 2010.

III. FUNDING SOURCE

USAID/Vietnam

IV. PURPOSE

The purpose of this Statement of Work (SOW) is to outline the tasks for a team of experts to

carry out an assessment of the disability and key health concerns in communities adjacent to

dioxin hot spots primarily in Danang and, to the extent feasible, in Phu Cat and Biên Hòa in that

order. In the course of carrying out this assessment, the team will perform the three

interrelated tasks: 1) a review the performance to date of the current USAID-funded disabilities

program in Danang which began in 2008 and is being implemented under grants to three NGOs.

(The performance/impact of the current program should be assessed in terms of the original

objectives established under the program and the broader disabilities needs of target

communities, as identified by the team.); 2) an assessment of other public health needs in those

communities, and 3) recommendations for potential future disability and health interventions in

the target communities within the financial parameters discussed later in this SOW.

V. BACKGROUND

Agent Orange and its contaminant dioxin are of concern to the Governments of Vietnam

(GVN), and the United States (USG), and the Vietnamese people. In the November 17, 2006

“Joint Statement Between the Socialist Republic of Vietnam and the United States of America,”

President Bush and President Triet agreed that “further joint efforts to address the

environmental contamination near former dioxin storage sites would make a valuable

contribution to the continued development of bilateral relations.” In 2007, President Bush

signed a $3 million bill for programs and activities for environmental remediation and health

projects addressing contamination near former dioxin storage sites in Vietnam. In 2009 and

2010, an additional $3 million and $4.9 million were appropriated, respectively, to continue

these efforts, leading to a combined three year total of $10.9 million. The U.S. Government and

the Government of Vietnam also have formed a Joint Advisory Committee (JAC) to provide

guidance on scientific cooperation, technical assistance, and environmental remediation related

to Agent Orange and dioxin contamination, and health-related activities for communities

adjacent to dioxin hotspots.


In 2008, as part of an effort to resolve the dioxin issues in Vietnam, USAID/Vietnam awarded a

total of $2,888,388 in grants to three NGOs - Vietnam Assistance to the Handicapped (VNAH),

The East Meets West Foundation (EMW), and Save the Children - to provide assistance to

people with disabilities (PWDs) living in communities adjacent to the hot spot in Danang. The

program assists PWDs regardless of the cause of their disability. The overall goal is to provide

comprehensive medical and social rehabilitation services for PWDs in communities adjacent to

the Danang hot spot, including health, education, livelihood and social integration needs so as to

help them fully integrate into society.

The three grants are scheduled to end by September 2011.

VI. SCOPE OF WORK

This assessment shall include three components:

First, it will assess the overall disability situation in communities adjacent to dioxin hotspots,

primarily in Danang and, to the extent feasible, Phu Cat and Biên Hòa. The team will identify

priority needs, gaps, challenges and opportunities for assistance interventions in those

communities.

The assessment will collect information about the strengths and weaknesses of the

implementation of the three USAID grants in meeting their objectives, evaluate the impact and

contributions to develop sustainable models for improving the quality of services for people

with disabilities in Danang (approximately30% of the LoE).

Second, the assessment will independently look at broader public health issues and needs

primarily in the communities adjacent to the hotspots in Danang, and, to the extent feasible,

other communities affected by dioxin contamination in Phu Cat and Biên Hòa (approximately

30% of the LoE). The Team will actively meet, solicit and analyze inputs from all major

stakeholders including relevant GVN agencies at the national and provincial level, including but

not limited to Office 33, MoLISA, the National Coordination Committee on Disabilities, and the

Danang People’s Committee, and commune leaders and residents of communities in areas

adjacent areas to dioxin hotspots, as well as USAID, CDC, HHS, other involved USG agencies

and other donors involving in the issue.

Third, the assessment will explore possibilities and provide recommendations for the future

restructuring, refocusing or expansion of the current disabilities including but not limited to

disability prevention, early intervention, and disability education and explore additional health

related intervention opportunities (approximately 40% LoE). Findings and recommendations

from this program assessment will be used to inform the design of possible follow-on activities.

These recommendations should primarily focus on the period FY 2011- FY 2015; unless some

tweaking of current activities is feasible in the limited time remaining prior to their termination

in FY 2011.

VII. METHODOLOGY

This external program assessment will:

1. Assess the progress, accomplishments, results and impact of the current three NGO grants

(approximately 30% LoE):

a. Assess whether the projects are on track to achieving their stated objectives including

strengths, weaknesses, and remaining gaps in service delivery, as well identifiable

constraints to successful project implementation.


b. Assess the extent to which the projects are addressing disability and public health needs

identified by the Assessment Team in the communities adjacent to dioxin hotspot.

c. Provide recommendations to improve current project, if feasible within the remaining

project implementation period.

Some illustrative questions include:

Program Management

a. Have the three projects established constructive working relationships with key

stakeholders (partners, government, NGOs, others)?

b. Do work plans and budgets reflect project priorities? How are they used as project

management tools?

Monitoring and Evaluation (M&E)

a. Is the M&E plan being implemented and kept up-to-date? How are data being used by

project management to make strategic and management decisions? With whom are the

data being shared and to what effect? How might M&E systems be improved?

b. What M&E systems are in place to monitor and follow the progress and trends of the

projects’ achievements?

c. How successful have the three projects been in providing valid and reliable strategic

information? How integrated are the projects’ M&E systems into those of the local

authorities?

1. Assess other public health needs in the communities adjacent to the hotspot in Danang, and

to the extent feasible, Phu Cat and Biên Hòa communities (approximately 30% LoE):

a. Determine the prevailing public health needs, issues and concerns from the perspective

of both providers and beneficiaries.

b. Assess both the support and gaps – financial, technical, political, etc – that currently

exist in meeting identified public health needs.

2. Provide recommendations for future (follow-on) assistance interventions that address

continuing disability and public health issues in communities surrounding dioxin hotspots,

primarily Danang, and to the extent feasible Phu Cat and Biên Hòa, within the funding

parameters indicated above and within GVN implementation capabilities. (approximately

40% LoE).

VIII. TEAM COMPOSITION, SKILLS AND LEVEL OF EFFORT

The program assessment will be implemented over a period of approximately four weeks with

three weeks for field work, beginning on/about November 29, 2010. The program assessment is

composed of a document review, interviews at the national level with relevant USG staff, GVN

ministries, NGO implementing partners and field visits to project sites in Danang and if, feasible,,

to other major hotspots in Phu Cat and Biên Hòa to assess the situation of communities

surrounding dioxin hotspots.

The consultants will be identified under the Global Health Technical Assistance Project

(GHTech) and a technical directive memo will be prepared. Consultants should be available

during the time indicated, and qualified and experienced to perform the terms of the statement

of work. As an external assessment, and under the guidance of USAID Vietnam’s GDO Office,

the team will work as an independent body funded by USAID but will actively solicit and

consider inputs from all major stakeholders at the national and local level including relevant


GVN and USG agencies, local government authorities, international and local NGOs and donors

involved in health and disabilities issues people living in the area adjacent to dioxin hotspots. The

team should be composed of 2 international consultants with the necessary skills and

qualifications to cover the following qualifications/positions:

Team Leader: Extensive experience in managing external program evaluations and strategy

development. Responsible for overall management of the assessment process including

communications, coordinating team members’ efforts, synthesizing reports and ensuring that

the team achieves the stated objectives.

Team member: Disability Specialist: Five to ten years extensive involvement in researching,

synthesizing and analyzing information on disabilities and services for people with disabilities

and at least five years’ experience in working with programs to assist people with disabilities.

Team member: Public Health Specialist: At least ten years’ experience in Public Health

programs and strategic planning, monitoring and evaluation, preferable as they related to

contaminated areas.

Illustrative LOE:

Team

Leader/Disability

Specialist

Public Health

Specialist

Background Reading 2 2

Assessment Methodology Development 2 2

International Travel (round trip) 2 4

Team Planning Meeting 2 2

Data gathering (site visits, meetings with

stakeholder, etc.) 10 10

Drafting Report 4 4

Debriefing/Submission of draft report 1 1

Report revision (draft report submitted to

USAID/V within 2 weeks of completion of field

work)

4 4

Final revised report submitted to USAID/V

(within 10 days of receiving their

comments/feedback on draft report)

3 3

Total—Estimated 30 days 32 days

A six day workweek is authorized while the team is in-country.

The team will also be assisted by local translator(s) as necessary throughout the course of the

in-country work.


IX. LOGISTICS

The USAID/Vietnam GDO staff will only provide limited logistics support for the assessment,

including provision of known contact points for actors in the disability and public health related

sector in Vietnam. All other logistical support, such as schedule preparation, hotel reservations,

transportation, and translation, will be provided by the contractor. The team is authorized to

hire a local logistics assistant, if necessary.

X. DELIVERABLES AND PRODUCTS

Prior to arrival: Team will develop an assessment methodology and field visit and interview

schedule in consultation with USAID/ Vietnam. USAID will provide supporting relevant

background documentation. Evaluation team members will arrive in-country having read the

material.

Within two days after team arrives in country: Team planning meeting and in-briefing

with USAID/Vietnam to review and comment on methodology, field visits and interview

schedule.

Prior to departure from Vietnam: The team will deliver a presentation on its findings and

recommended strategy to the Mission and a separate presentation to key stakeholders including

relevant USG agencies and GVN national and local representatives. The Team Leader will

submit a draft report to USAID/Vietnam, one hard copy and one electronic copy on a CD ROM

or flash drive.

Within two weeks after completion of the fieldwork in Vietnam: A draft report of the

assessment findings and recommendations, with supporting analyses and documentation, will be

submitted to the USAID/Vietnam General Development Office for comments.

USAID will collect comments from the relevant stakeholders and provide these comments to

the team within 10 working days from receipt of the draft report.

After the mission provides signoff on the final report, GH Tech will have the document

professionally edited and formatted for public distribution. Please note this process will take

approximately 30 days. GH Tech will submit the final edited and formatted report to USAID/V

in electronic form, and no printed copies of the document will be required.

The contractor shall also submit the final assessment report to USAID at

[email protected]. For information on what is required and how to send it, see the web

page at http://www.dec.org/submit.cfm.

XI. RELATIONSHIPS AND RESPONSIBILITIES

Client Roles and Responsibilities:

Before In-Country Work

1. Consultant Conflict of Interest. To avoid conflicts of interest or the appearance of a COI,

review previous employers listed on the CV’s for proposed consultants and provide

additional information regarding potential COI with the project contractors or NGOs

evaluated/assessed and information regarding their affiliates.

2. Documents. Identify and prioritize background materials for the consultants and provide

them, preferably in electronic form.

3. Local Consultants. Assist with identification of potential local consultants and provide

contact information.

mailto:[email protected]

http://dec.org/submit.cfm


4. Site Visit Preparations. Provide a list of site visit locations, key contacts, and suggested

length of visit for use in planning in-country travel and accurate estimation of country travel

line items costs. Missions can protect scarce budgets by using their in-country knowledge to

suggest the travel calendar (i.e. number of in-country travel days required to reach each

destination, and number of days allocated to interviews at each site).

5. Lodgings and Travel. Provide guidance on recommended secure hotels and methods of in-

country travel (i.e., car rental companies and other means of transportation) and identify a

person to assist with logistics (i.e., visa letters of invitation etc.)

During In-Country Work

1. Mission Point of Contact. Throughout the in-country work, ensure constant availability of

the Mission Point of Contact person(s) and provide technical leadership and direction for

the team’s work.

2. Meeting Space. Provide guidance on the team’s selection of a meeting space for interviews

and/or focus group discussions (i.e. USAID space if available, or other known office/hotel

meeting space).

3. Meeting Arrangements. While local consultants typically will arrange meetings for contacts

outside the Mission, support local consultant(s) in coordinating meetings with stakeholders.

4. Formal and Official Meetings. Arrange key appointments with national and local government

officials and accompany the team on these introductory interviews (especially important in

high-level meetings).

5. Other Meetings. If appropriate, assist in identifying and helping to set up meetings with local

professionals relevant to the assignment.

6. Facilitate Contacts with Partners. Introduce the team to project partners, local government

officials and other stakeholders, and where applicable and appropriate, prepare and send out

an introduction letter for team’s arrival and/or anticipated meetings.

After In-Country Work

1. Timely Reviews. Provide timely review of draft/final reports and approval of the deliverables.

XII. MISSION AND/OR WASHINGTON CONTACT PEOPLE/PERSON

Van Le

USAID/Vietnam

Timothy Meinke

USAID/Vietnam

For more information, please visit;

http://resources.ghtechproject.net

Global Health Technical Assistance Project

1250 Eye St., NW, Suite 1100

Washington, DC 20005

Tel: (202) 521-1900

Fax: (202) 521-1901

www.ghtechproject.com